| NPI | 1790205052 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33940) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID 100407) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2018-07-02 |